Health insurance exchanges

Health insurance exchanges, or marketplaces, are a key part of federal health reform under the ACA that allow individuals and small employers to shop for insurance coverage.

Health insurance exchanges are intended to:
  • Help consumers better understand their health insurance options
  • Provide a more standardized market in which to shop for health plans
  • Provide financial assistance for those who qualify
The Oregon Health Insurance Exchange, also known as Cover Oregon, will open for business in October . Employers are not required to participate in Cover Oregon and may continue to purchase coverage in the private market through a producer or directly from an insurance carrier. A wide variety of plan options for small groups will be available from Providence Health Plan through Cover Oregon and the private market.

Participating in Cover Oregon SHOP
Small-group employers who wish to participate in the Small Business Health Options Program, SHOP, in Cover Oregon must adhere to these rules:
  • At least 51 percent of employees must be employed in Oregon.
  • Seventy-five percent or more of the small group's employees must be enrolled in the health plan (50 percent for dental).
  • The minimum employer contribution toward employee-only premium is 50 percent.
  • The tiers of coverage are employee only, employee and spouse, employee and children, and family.
  • Employers may offer coverage for registered domestic partners only, or for all domestic partners, including non-registered and same-sex partners.
  • Employees must be enrolled by the 22nd day of the month prior to the coverage effective date.
  • Policy premium rates will be locked in for 12 months.
  • If rehired within nine months, the eligibility waiting period is waived.
Cover Oregon's online marketplace will allow small-group employers to provide employees with a broad selection of medical and dental plan options under the defined contribution model. Employers will be able to contribute a set dollar amount toward their employees' health insurance coverage and let employees shop on Cover Oregon for the carrier and plan that best meets their needs. Employers and employees will be able to compare, select and enroll in their medical and dental plans on the Cover Oregon website.

Small-group employers will have the ability to select from four options in offering employees a plan in Cover Oregon:
  1. Broad choice. Employees can select from multiple carriers and plans.
  2. Multiple carriers/one plan. The employer selects a benefit plan level, and employees can select a plan from all carriers.
  3. Plan bundling. The employer chooses one insurance carrier but gives employees the ability to select from all plans offered by that carrier.
  4. Traditional. The employer chooses one insurance carrier and one plan for employees.
Financial assistance and tax credits for small groups
A small employer tax credit is available through the Internal Revenue Service, or IRS, to help cover the cost of premiums. To qualify, small employers must:
  • Provide health insurance to employees and cover at least 50 percent of the cost of coverage.
  • Employ fewer than 25 full-time workers (employers with fewer than 50 part-time workers may be eligible).
  • Pay average annual wages below $50,000.
Starting in 2014, the credit will cover up to 50 percent of premium costs for taxable organizations and up to 35 percent for tax-exempt organizations. For more information on how to qualify, contact a CPA or a tax professional, or consult the IRS.